Compliance 101 |
Vol. VIII, No. 35 – October 20, 2006 | Contact: Margaret Dragon, Editor, (781) 593-4924
Please direct all comments to subscriptions@hcca-info.org.
Subscribe & unsubscribe information is at the bottom of this email click
here.
About HCCA | HCCB Certification | Shop Online | Events | Career Opportunities
NEW DATE - NEW HOTEL
OIG 2007 Work Plan Most Comprehensive OIG Work Plan Ever! Discover the New Focus Part I: What's in the New Plan for Hospitals? Part II: Physician Focus |
||
Tri-State Local
South Central Local
October 23–26, 2006 Harrah’s Las Vegas CHC Exam Application
December CHC Exam Application, Deadline October 26, 2006
February
 Compliance Academy
March
Compliance Academy
June
 Advanced Academy
June
|
||
| Products | ||
The NEW Health Care Auditing & Monitoring Tools
The NEW Health Care Auditing & Monitoring Tools features dozens of tools, policies, and procedures used in auditing and monitoring programs. Includes CD-ROM. Preview the manual Compliance 101 |
||
| This Week's HCCA Corporate Members | ||
|
|
Advanced Academy
Compliance Academy
Table of Contents
Headlines
Texas OIG Investigates Medicaid Fraud
AMR Settlement announced
Husband and Wife Plead Guilty to Fraud
CA Homecare Business Owner Sentenced
Regulatory News
CMS Updates and Announcements
In the Federal Register
Court Cases and Administrative Actions
From the GAO
CMS Transmittals
From the OIG
Visit
HCCA's Web site
HCCA
Headquarters - Contact Information
Headlines:
Texas OIG Investigates Medicaid Fraud
On October 18, The Bryan-College Station Eagle reported that “Three Grimes County sheriff's deputies resigned last week following an investigation into Medicaid fraud, the sheriff's office announced Tuesday.
“Sheriff Don Sowell said the resignations of an investigator and two sergeants came at the conclusion of a two-month investigation by the Austin-based Health and Human Services Commission of the Office of the Inspector General. The agency typically investigates cases of Medicaid and Medicare fraud, Sowell said.
Angela Schroeder is suspected of tampering with a government record, a third-degree felony, authorities said. She was employed with the sheriff's department for about seven years.”
Angela Schroeder is suspected of tampering with a government record, a third-degree felony, authorities said. She was employed with the sheriff's department for about seven years. For more: http://www.theeagle.com/stories/101806/local_20061018004.php
***top***
AMR Settlement announced
On October 5, the US Department of Justice announced that American Medical Response Inc. (AMR), one of the nation’s largest ambulance providers, has paid the United States over $9 million to resolve allegations that the company violated the False Claims Act, the Justice Department announced. The government alleged that the ambulance company provided illegal inducements to hospitals in Texas in exchange for referrals.
The settlement relates to allegations that the Greenwood, Colo.-based company provided or offered inducements to Texas hospitals in the form of contracts known as “swapping arrangements.” Such contracts gave the medical facilities discounts on transports in exchange for the referral of all or some of the ambulance transports of patients being discharged from the hospitals, which were billed to Medicare.
For more: http://www.usdoj.gov/opa/pr/2006/October/06_civ_679.html
***top***
Husband and Wife Plead Guilty to Fraud
On October 18 the US Attorney for the Southern District of Florida R. Alexander Acosta announced that Rita Cardoso and her husband, Luis Delgado, of Miami, owners and operators of several health care related businesses located in Miami-Dade County, pled guilty before United States District Court Judge Jose E. Martinez in Miami, Florida.
Cardoso and Delgado were charged in separate cases with defrauding the Medicare Program of more than 4 million dollars through fraudulent billings for durable medical equipment. Durable medical equipment (DME) is equipment that is designed for repeated use and for a medical purpose and include items such as prosthetic limbs, back braces, knee braces, and wheelchairs. Cardoso and Delgado billed Medicare for more than $17 million for the equipment which they allegedly provided to their customers. Cardoso and Delgado were also charged with structuring withdrawals of Medicare funds for under $10,000 to avoid having the banks file currency transaction reports with the Department of Treasury. Cardoso and Delgado also plead guilty to conspiracy to commit wire and mail fraud charges in a separate Information. For more:
http://www.usdoj.gov/usao/fls/PressReleases/061018-01.html
***top***
CA Homecare Business Owner Sentenced
On October 17, Associated Press reported that “The owner of California's two largest home health care businesses was sentenced Monday to nearly four years in prison for committing fraud that cost Medicare $40 million.
“U.S. District Judge Stephen Wilson sentenced Lourdes "Lulu" Perez, 53, of San Diego to 46 months in prison and three years probation. She was also ordered to repay $7 million.Perez earlier pleaded guilty to health care fraud and filing false tax returns. As part of the settlement she, her husband and her two businesses agreed to repay $33.9 million to the government.
“Perez was the owner of Los Angeles-based Provident Home Health Care and San Dimas-based Tri-Regional Home Health Care, which billed Medicare for work that was never performed, according to her plea agreement.
“She came under federal investigation after a payroll clerk at Provident filed a whistleblower lawsuit in 2003. The government intervened in the case, and a co-conspirator agreed to plead guilty. The elaborate fraud scheme occurred from October 2002 to September 2003, when Medicare halted payments to Provident and Tri-Regional and authorities seized more than $20 million in assets, prosecutors said.”
***top***
This week, MediRegs provided TWCC readers with the following Regulatory information: Court Cases and Administrative Actions, From the GAO, CMS Transmittals, and From the OIG.
Regulatory News
CMS Update
NPI
9/26 NPI Roundtable Transcript Available Now
The transcript for the 9/26 NPI Roundtable can be found at http://www.cms.hhs.gov/EducationMaterials/Downloads/ NationalProviderIdentifierRoundtable.pdf on the CMS website.
NPI Training Package: Module 5 Available Now
Module 5, Medicare Implementation, provides the NPI requirements specific to Medicare providers. This module will be updated as new requirements are announced or changes are made. Module 5 is now posted at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/ NPI_Training_Package.pdf on the CMS NPI Page.
October 25th WEDI Audiocast
Registration is open for the WEDI audiocast “NPI 101 – And We’re Off! Getting Up To Speed On NPI” to be held on October 25th from 2-3:30PM ET. Learn more about this audiocast, and how to register, at http://www.wedi.org/npioi/index.shtml on the WEDI website. Please note - there is a cost to participate in this audiocast.
As always, more information and education on the NPI can be found at the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.
****
Quarterly Update for Average Sales Price Medicare Part B Drugs
The October 2006 quarterly update for the Average Sales Price (ASP) Medicare Part B Drugs pricing file has been posted on the Centers for Medicare & Medicaid Services (CMS) website at
http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/ 02_aspfiles.asp .
***
News from the Medicare Learning Network
Below are some recently-released new MLN Matters articles that I thought might be of interest to you:
MM5256 – October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/MM5256.pdf
MM5107 – New Durable Medical Equipment Prosthetic, Orthotics, and Supplies (DMEPOS) Transcutaneous Electrical Nerve Stimulators (TENS) Certificate of Medical Necessity (CMN) for Purchases
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/MM5107.pdf
MM5272 – October Update to the 2006 Medicare Physician Fee Schedule (MPFS) Database
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/MM5272.pdf
SE0663 – Notifying Medicare Patients about Lifetime Reserve Days (LRDs)
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/SE0663.pdf
SE0674 – Holding of Pancreas Transplant Alone (PA) Claims - Amendment to MLN Matters Article MM5093
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/SE0674.pdf
MM5276 – Fiscal Year (FY) 2007 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH), and Inpatient Psychiatric Facility (IPF) PPS Changes
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/MM5276.pdf
MM5304 – October 2006 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/MM5304.pdf
MM5308 – Ending the Contingency Plan for Remittance Advice (RA) and Charging for PC Print, Medicare Remit Easy Print (MREP), and Duplicate RAs
http://www.cms.hhs.gov/MLNMattersArticles/ downloads/MM5308.pdf
***
Competitive Acquisition Program (CAP)
Physicians participating in the Medicare Part B Drug Competitive Acquisition Program (CAP) are encouraged to subscribe to the new CMS-CAP-Physicians-L mailing list to receive pertinent and timely information regarding the CAP. Go to http://www.cms.hhs.gov/apps/mailinglists/ default.asp?audience=3 , then subscribe to the CMS-CAP-Physicians-L mailing list.
As a reminder, the 2007 physician election period for the Medicare Part B Drug Competitive Acquisition Program (CAP) began on October 1, 2006 and concludes on November 15, 2006. The CAP is an alternative to the Average Sales Price (ASP) method of acquiring many drugs and biologicals administered incident to a physician’s services.
CAP physician election is an annual process that provides an opportunity for physicians who are not participating in the CAP to join. Physicians who are currently participating in the CAP must submit an election form in order to continue participation or to terminate participation. Physicians who are not participating in the CAP and do not wish to participate in the CAP at this time are not required to take any action. Completed and signed physician election forms should be returned by mail to your local carrier. Forms must be postmarked on or before November 15, 2006.
Additional information about the CAP is available at http://www.cms.hhs.gov/CompetitiveAcquisforBios/ 01_overview.asp .
Additional information about the 2007 CAP physician election process is at http://www.cms.hhs.gov/CompetitiveAcquisforBios/ 02_infophys.asp .
The list of drugs supplied by the CAP vendor, including NDCs, is in the Downloads section at http://www.cms.hhs.gov/CompetitiveAcquisforBios/ 15_Approved_Vendor.as
***top***
In the Federal Register
October 16 - Final Rule
Medicaid Program; State Allotments for Payment of Medicare Part B
Premiums for Qualifying Individuals: Federal Fiscal Year 2006 and
Fiscal Year 2007
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/ edocket.access.gpo.gov/2006/E6-17033.htm
***top***
Court Cases and Administrative Actions
Provider Reimbursement Review Board Decisions
PRRB 09/12/06 06-D48 District of Columbia General Hospital - indirect medical education reimbursement:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=hc_bd_pr&u=2006D48&h=top1.html&t=80&s=twcc
PRRB 09/07/06 06-D47 Rush University Medical Center - aggregation methodology re reasonable compensation equivalent:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=hc_bd_pr&u=2006D47&h=top1.html&t=80&s=twcc
PRRB 09/07/06 06-D46 Sisters of Charity Hospital - indirect medical education reimbursement:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=hc_bd_pr&u=2006D46&h=top1.html&t=80&s=twcc
PRRB 09/01/06 06-D45 The Milton S. Hershey Medical Center - exception to the End Stage Renal Disease composite rate:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=hc_bd_pr&u=2006D45&h=top1.html&t=80&s=twcc
PRRB 08/29/06 06-D44 DCH Regional Medical Center - pension costs as wage-related costs:
http://twcc.mediregs.com/cgi-bin/_trial/ efgn?c=hc_bd_pr&u=2006D44&h=top1.html&t=80&s=twcc
PRRB 08/29/06 06-D43 Greenwood County Hospital - low-volume adjustment:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_pr&u=2006D43&h=top1.html&t=80&s=twcc
PRRB 08/04/06 06-D42 Logos Healthcare Rehabilitation, Inc. - reimbursement re numerous expenses:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_pr&u=2006D42&h=top1.html&t=80&s=twcc
PRRB 07/28/06 06-D41 Comprehensive Home Care, Inc. - disallowance of accrued compensation:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=hc_bd_pr&u=2006D41&h=top1.html&t=80&s=twcc
CMS Departmental Appeals Board Appellate Division Decisions
DAB(APP) 07/27/06 - 2037 - New York State Department of Health - payments for the care of inmates in state custody:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mms_dec_dabap&u=dab2037&h=top1.html&t=80&s=twcc
***top***
From the GAO
Medicaid Third-Party Liability: Federal Guidance Needed to Help States Address Continuing Problems. GAO-06-862, September 15.
http://www.gao.gov/cgi-bin/getrpt?GAO-06-862
Medicare Integrity Program: Agency Approach for Allocating Funds Should Be Revised GAO-06-813, September 6, 2006 (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_gao_cms&u=d06813&h=top1.html&t=80&s=twcc
***top***
CMS Transmittals
Medicare Claims Processing (PUB. 100-04)
Transmittal #1075, 2007 Healthcare Common Procedure Coding Systems Annual Update Reminder:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1075cp&h=top1.html&t=80&s=twcc
Transmittal #1073, Indian Health Service Hospital Payment Rates for Calendar Year 2006:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1073cp&h=top1.html&t=80&s=twcc
Transmittal #1072, 06/2006 Inpatient Prospective Payment System Outlier Reconciliation Technical Corrections:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_04&u=mrepm10004r1072cp&h=top1.html&t=80&s=twcc
Financial Management (PUB. 100-06)
Transmittal #108, Notice of New Interest Rate for Medicare Overpayments and Underpayments 1st Qtr. FY 2007:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_6&u=mrpm10006r108fm&h=top1.html&t=80&s=twcc
Program Integrity (PUB. 100-08)
Transmittal #165, Durable Medical Equipment Medicare Administrative Contractors Adoption or Rejection of Local Coverage Determinations Recommended by Durable Medical Equipment Program Safeguard Contractors:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mr_pm_100_08&u=mrpm10008r165pi&h=top1.html&t=80&s=twcc
CMS One-Time Special Notification (PUB. 100-20)
Transmittal #241, Update to the Medicare Part B 835 Flat File:
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_pm_100_20&u=mrepm10020r241otn&h=top1.html&t=80&s=twcc
***top***
From the OIG
Audit Reports
Graduate Medical Education for Dental Residents Claimed by St. Luke's Episcopal Hospital for Fiscal Years 2000 Through 2002 (A-04-04-06004; 09/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=40406004&h=top1.html&t=80&s=twcc
Audit of Selected States' Medicaid Payments for Services Claimed To Have Been Provided to Deceased Beneficiaries (A-05-05-00030; 09/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=50500030&h=top1.html&t=80&s=twcc
Duplicate Medicare Payments to Cost-Based Health Maintenance Plan Scott & White Health Plan for the Fiscal Years 2002, Through 2004 (A-05-06-00031; 09/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=50600031&h=top1.html&t=80&s=twcc
Duplicate Medicare Payments to Cost-Based Health Maintenance Plan Capital Health Plan, Inc. for Fiscal Years 2002 Through 2004 (A-05-06-00029; 09/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oas_cms2005&u=50600029&h=top1.html&t=80&s=twcc
Evaluation and Inspection Reports - Centers for Medicare and Medicaid Services
Carrier Determination of Copayments for Medicare Mental Health Services PDF (OEI-09-04-00221; 10/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oei_cms&u=oei090400221&h=top1.html&t=80&s=twcc
Medicaid Provider Enrollment Safeguards: Medical Equipment Providers PDF (OEI-04-05-00180; 10/2006) (PDF):
http://twcc.mediregs.com/cgi-bin/_trial/efgn?c=mre_oig_oei_cms&u=oei040500180&h=top1.html&t=80&s=twcc
***top***
Acronym Library
| NDMS | National Disaster Medical System |
| NDPS | National Drug Pricing System |
| NDR | National Death Repository (SSA) |
For more from CMS Acronyms: http://www.cms.hhs.gov/acronyms/listall.asp
***top***
Visit HCCA's Web site, http://www.hcca-info.org
NOTE: HCCA Members please contact April Kiel at april.kiel@hcca-info.org
if you have not received your password. This new
Web site allows members and visitors to register for conferences, order
products, or join HCCA online. HCCA Members can
update membership information and search for compliance resources
online in a secure environment, without faxing, emailing and other time-consuming
activities.HCCA's Web site
also offers E-Communities, which allow regional and
industry specific information to be shared through a discussion forum
and list-serve. Members can view and respond to documents,
tools, forms, policies and other information posted by Regional and Compliance
Focus Group leaders!
Visit http://www.hcca-info.org
and see for yourself.
***top***
HCCA Headquarters
- Contact Information Your HCCA Office
is located at:
6500 Barrie Road, Suite 250
Minneapolis, MN 55435
The HCCA Toll-Free
888/580-8373,
Fax number - (952)
988-0146
MN telephone number-
(952) 988-0141
Email - info@hcca-info.org Contact: Margaret
Dragon, Editor
This Week in Corporate Compliance (781) 593-4924
To subscribe to TWCC click here